• Vol. 43 No. 10, 511–514
  • 15 October 2014

A Double-Blind, Randomised, Placebo-Controlled Trial of EMLA® Cream (Eutectic Lidocaine/Prilocaine Cream) for Analgesia Prior to Cryotherapy of Plantar Warts in Adults

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ABSTRACT

Introduction: Cryotherapy with liquid nitrogen is an effective, safe and convenient form of treatment for plantar warts. EMLA® cream (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) is a topical local anaesthetic agent that has proven to be effective and well tolerated in the relief of pain associated with various minor interventions in numerous clinical settings.

Materials and Methods: In a single-centre, double-blind, randomised placebo-controlled study, 64 subjects were randomised into 2 groups. The subjects had a thick layer of EMLA® cream or placebo cream applied to pared plantar wart(s) and onto the surrounding margin of 1 mm to 2 mm under occlusion for 60 minutes prior to receiving cryotherapy. The pain of cryotherapy was evaluated by the subjects using a self-administered Visual Analogue Scale (VAS) immediately after the cryotherapy.

Results: There was no statistical difference between the mean VAS score for EMLA® cream (47.0 ± 21.4 mm) and placebo (48.9 ± 22.0 mm). Those with more than 1 wart had a significantly higher VAS score than those with only 1 wart (59.1 ± 21.8 vs. 44.3 ± 20.4, P <0.05) but this did not affect the therapeutic effect of EMLA® cream prior to cryotherapy.

Conclusion: We conclude that the application of EMLA® cream prior to cryotherapy does not reduce the pain associated with cryotherapy.


Plantar warts are commonly diagnosed in dermatology clinics. They are painful, contagious and have the potential to cause considerable morbidity. Among the therapeutic modalities, cryotherapy with liquid nitrogen is an effective, safe and convenient form of treatment for plantar warts. However, therapeutic doses of liquid nitrogen can produce pain caused by the stinging sensation and the inflammation during the freezing cycle. It is not unbearable and usually short-lived. The wart will begin to turn white; this is a sign that the skin cells are dying. A blister may also form at the site of the wart. It is important to leave the blister alone; it will heal within a week.

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